Diaper Rash

Diaper rash is a common skin condition characterized by redness and irritation in the area covered by a diaper. This includes:

• The genital area
• The buttocks
• The lower back
• The abdomen
• The inner thighs.

Most often found in babies, it is also known as: 1

• Nappy rash
• Diaper dermatitis
• Irritant diaper dermatitis.

Diaper rash is a type of inflammation most often caused by wetness, skin sensitivity, or chafing, though it can also be caused by certain medications or chemicals.

While uncomfortable, it is usually a mild condition that can be successfully treated at home.

If you think your little one might have nappy rash, try using our free symptom assessment with the Ada app.

One of the more common conditions among infants, diaper rash affects as many as one in three babies at any given time, 2 with boys and girls being equally susceptible. It ranges from mild to moderate to severe irritation.

Mild diaper rash: Manifests as a faint pinkness that is limited to a small area and does not usually cause distress to the infant.

Moderate to severe diaper rash: Tends to be brighter red and more widespread, and it may feature noticeable swelling, blisters and ulcerated areas. The resultant pain can cause significant distress. This type of nappy rash should be checked for signs of infection. 1 3 4

Parents and caregivers can prevent diaper rash by changing their baby’s diapers often and promptly, especially when there is stool present. It is recommended that they cleanse the skin gently but thoroughly, making sure the area under the diaper is dry, and apply barrier creams when necessary.

Many parents feel ashamed when their child develops diaper rash, because they believe they have been neglectful somehow. However, even the most careful parents have to deal with it. Almost every baby will experience the condition at least once.

Provided that the rash is treated properly, it usually disappears within a few days and does not have any long-term health effects.

It is important to determine whether the skin irritation is mild or severe. Usually, it is fairly easy to make this distinction. One of the first signs of diaper rash is redness in the area that is usually covered by the diaper. In mild cases, this can be a faint pinkness. Other symptoms include the following:

The following symptoms are typical of mild diaper rash:

• Pink or red patches
• A few scattered pimples
• Slight scaling and dryness
• Stinging sensation when passing urine or feces

The following symptoms are typical of severe diaper rash:

• Extensive redness
• Soreness in the area
• Pimples
• Ulceration
• Blisters
• Dry, cracked skin
• Infant is visibly distressed

In all cases, the skin may feel warm and puffy to the touch. If treated as soon as symptoms become apparent, the rash should clear up quickly and with minimal fuss. Mild cases of diaper rash can usually be treated at home. If the rash is severe, or symptoms persist or worsen, it is important to seek medical help. Do any of the symptoms above sound familiar? Try an asessment on the Ada app.

There are many different possible causes of diaper rash and sometimes there is more than one irritant to blame at one time. The following are the most likely causes: 5

• Prolonged exposure to urine and feces: The wetness and ammonia can irritate the skin
• Friction (chafing): The diaper may rub against the skin, causing irritation. This often happens when the diaper is too tight or, in older babies, when grains of sand or crumbs get under the diaper while they are playing or eating
• Sensitive skin: Conditions such as eczema and seborrheic dermatitis may increase the risk of a baby developing diaper rash. However, these conditions are usually not limited to the diaper area
• Intolerance to a product: The skin may react to one of the ingredients in a new product, such as baby wipes, lotions, soaps, different brands of disposable diapers, and detergents and softeners used on cloth diapers.
• New foods in the diet: Diaper rash often develops when a baby starts eating solid foods. The content and frequency of their stools can change, causing skin irritation. Breast-fed infants can also develop diaper rash in reaction to something their mother has eaten.
• Yeast or bacterial infection: The warmth and moisture of the diaper area make it susceptible to bacteria and yeast (candida) infections. The creases of the skin are particularly vulnerable and may become red, with scattered red dots nearby.
• Antibiotics: By killing good bacteria along with the bad, antibiotics, whether taken by an infant or their breastfeeding mother, can upset the balance of the skin flora. Yeast infections can develop as a result. Antibiotics can also cause diarrhea, which irritates the skin.

If the diaper rash does not go away despite resolution of the suspected causes, a doctor’s opinion should be sought to:

• Identify the triggers
• Treat the rash
• Prevent it from recurring or worsening.

Doctors usually diagnose diaper rashes by taking a history and conducting a physical examination. Unless they suspect an allergy or rare deficiency, they are unlikely to perform laboratory tests. 6

A medical practitioner will be able to differentiate diaper rash from other skin conditions such as eczema and seborrheic dermatitis, and advise on the best course of action. In the case of mild diaper rash, a home diagnosis is usually made by caregivers, based on the symptoms presented by the infant.

Mild cases of diaper rash can be treated at home, without a visit to the doctor or special medications. Taking simple steps to improve the infant’s skin care will usually clear the rash.

Leave the diaper off for as long as possible. This will allow the area to air-dry and aid healing. You can lay the infant on an absorbent towel if necessary. The following steps can also be taken:

• Changing diapers frequently, including at night.
• Cleaning the skin with warm water, using a gentle, fragrance-free soap if necessary. Avoid wipes, as these can be irritating. Take care not to rub too hard, and always wipe the genital area from front to back.
• After cleaning, pat the skin dry with a soft cloth or allow it to air-dry.
• Bathing the infant no more than twice a day to stop the skin drying out.
• Avoiding baby powders as they can aggravate the inflammation.
• Gently applying a barrier cream or ointment after diaper changes. This will reduce the contact between skin and waste products, helping to prevent further irritation. Zinc cream, zinc oxide and petroleum jelly are all options. Natural alternatives, such as creams containing marigold extract, are available too. A pharmacist will be able to advise on which product to use. 2
• Ensuring that the diaper is not too tight.
• Trying a different brand of diaper to see if it might help.
• Using fragrance-free, hypoallergenic detergents and softeners when washing cloth diapers and baby clothing.
• Introducing new foods slowly to see whether there is a connection. 7
• If a food item seems to be problematic, removing it from the baby’s diet for a few days and reintroducing it slowly, checking for a reaction.

If the rash is severe, persists or worsens despite the above interventions, it is advisable to consult a pharmacist or doctor. If there are any signs of pus, bleeding or fever, medical care should be sought immediately.

A doctor may prescribe a special treatment for the rash. This could include:

• A mild hydrocortisone (steroid) cream
• An antifungal ointment
• Topical or oral antibiotics (in the case of bacterial infections).

Hydrocortisone creams should only be used if deemed necessary by a doctor, as they can cause additional problems. 8

If the rash does not respond to any of these treatments, the doctor may refer the infant to a specialist to get to the bottom of the problem.

Diaper rash can often be prevented by practicing what is known as good diaper care. This involves keeping three keywords in mind: 9

• Clean
• Dry
• Apply

And taking the following steps: 1 10

• Changing diapers as soon after soiling as possible to reduce skin exposure to urine and feces.
• Cleaning the diaper area thoroughly with warm water alone, using a gentle, fragrance-free soap only where absolutely necessary. Use soft cloths or cotton balls and wipe gently. If you are using baby wipes, make sure they are mild and alcohol-free.
• Drying the skin by patting it with a clean towel, or allow the diaper area to air-dry.
• Avoid talcum powder, cornstarch and other drying powders, as these can cause skin irritation.
• Applying a barrier ointment regularly to protect the skin.
• Checking that the diaper is not too tight.
• Washing the hands with soap after changing the diaper to prevent the spread of germs.
• Set aside periods where the diaper can be left off for a while.
• When the infant starts taking a course of antibiotics, pre-empt diaper rash by applying barrier creams.

Q: Can adults get diaper rash?
A: Yes, diaper rash can affect adults too. Anyone who wears diapers or incontinence briefs can develop diaper rash, regardless of their age. They may notice the following around the genitals:

• Pain
• Swelling
• Redness

The causes and treatments of diaper rash in adults are similar to those in infants.

It is important to check that the diapers or briefs fit well to minimize friction, and ensure that they are changed often so that moisture is not left to accumulate. The genital area must be cleaned and dried properly at each change. To avoid causing further irritation, warm water and a fragrance-free, alcohol free cleanser should be used. A mild repair cream can provide relief. Hydrocortisone and antibiotic ointments should not be applied unless prescribed by a doctor. Patients can also increase their fluid intake to dilute their urine, making it less irritating to the skin.

The affected adult should seek medical advice if there are any signs of infection, such as:

• Blisters
• Pus
• Fever
• The rash spreading to other parts of the body
• The rash not going away in three to four days.

Persistent or frequent diaper rash in adults may be a sign of neglect or abuse. 11

Q: Can you use diaper rash cream for acne?
A: Some people claim to have used diaper rash cream to treat their facial pimples and acne, touting the protective properties of zinc oxide for the skin. However, medical practitioners do not recommend using dedicated diaper rash creams for anything other than the treatment of diaper rash. Off-label use, particularly of products containing hydrocortisone, could cause contact dermatitis and actually worsen acne. 12 It is advisable to consult a dermatologist about appropriate treatments for acne.

Read more about treating acne »

Q: Is diaper rash related to teething in babies?
A: In the past, diaper rash was often thought to be related to teething in babies. Many caregivers believed that teething could lead to loose stools and result in diaper rash. However, modern studies have found that teething is not typically a cause of diaper rash. 13 If your child is showing symptoms of diaper rash, the condition should be treated as outlined above.

• Nappy rash
• Irritant diaper dermatitis
• Diaper candidiasis